Posts

Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such as viral illness and allergy.

How do I know when my child has sinusitis?

The following symptoms may indicate a sinus infection in your child:

  • a cold lasting more than 10 to 14 days, sometimes with a low-grade fever
  • thick yellow-green nasal drainage
  • post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
  • eadache, usually in children age six or older
  • irritability or fatigue
  • swelling around the eyes

Young children are more prone to infections of the nose, sinus and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, if your child remains ill beyond the usual week to ten days, a sinus infection may be the cause.

You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. Over-the-counter decongestants and antihistamines are not generally effective for viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is not well defined. Such medications should not be given to children younger than two years old.

If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis: If your child suffers from one or more symptoms of sinusitis for at least 12 weeks, he or she may have chronic sinusitis. Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek consultation with an otolaryngologist (an ear, nose and throat – ENT – specialist). The ENT may recommend medical or surgical treatment of the sinuses.

Diagnosis of sinusitis: If your child sees an ENT specialist, the doctor will examine his/her ears, nose and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how completely your child’s sinuses are developed, where any blockage has occurred and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural changes, allergies, and problems with the immune system.

When Is Surgery Necessary for Sinusitis?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child’s sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child’s sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.

Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.

Summary

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy and swelling around the eyes, along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. In the rare child where medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

¿Qué es la otitis media?

Otitis media se refiere a la inflamación del oído medio. Cuando la infección ocurre esta condición es llamada “otitis media aguda”. La otitis media aguda ocurre cuando un resfrío, alergia o infección de las vías respiratorias superiores y la presencia de bacterias o virus llevan a la acumulación de pus y moco detrás de la membrana timpánica bloqueando la trompa de Eustaquio. Esto causa dolor de oído e hinchazón.

Cuando se forma líquido en el oído medio, la condición es conocida como “otitis media con efusión”. Esto sucede en una infección en recuperación o cuando una infección esta por ocurrir. El líquido puede permanecer en el oído por semanas hasta algunos meses. Cuando una descarga del oído persiste o se hace recurrente es llamada a veces infección crónica de oído medio. El líquido puede permanecer en el oído hasta tres semanas después de la infección. Si no es tratada, la infección crónica del oído puede tener consecuencias potenciales serias como pérdida auditiva transitoria o permanente.

¿Como afecta la otitis media la audición del niño?

Todos los chicos con infección de oído medio o líquido tienen un grado de pérdida auditiva. La pérdida promedio en oídos con secreción es de 24 decibeles, equivalente a usar auriculares (24 decibeles es el nivel aproximado de los silbidos leves). Líquidos más espesos pueden causar una pérdida mucho mayor, de hasta 45 decibles (el nivel de la conversación normal)
Su niño puede tener pérdida de la audición si no es capaz de entender ciertas palabras y habla a un volumen mayor del normal. Básicamente, un chico con pérdida auditiva debida a infecciones de oído medio escuchará sonidos poco claros y perderá de entender algunos diálogos en menor medida que aquellos con hipoacusias profundas. De todas formas las consecuencias pueden ser importantes – el paciente joven pueden perder en forma permanente la habilidad de entender en forma concisa el diálogo en ambientes ruidosos (como el aula de la escuela) llevando a un retraso en el aprendizaje de importantes habilidades de lenguaje.

Tipos de hipoacusias

La hipoacusia conductiva es una forma de dificultad auditiva debida a una lesión el en canal auditivo externo o en el oído medio. Esta forma de hipoacusia es generalmente transitoria y se encuentra en personas de 40 años o menos. Infecciones de oído crónicas no tratadas pueden llevar a una hipoacusia conductiva; drenar el oído medio infectado a través de la membrana timpánica lleva de nuevo la audición a la normalidad.

La otra forma de hipoacusia es la neurosensorial, pérdida auditiva debida a una lesión en la rama auditiva del VIII par craneal o del oído interno. Históricamente esta condición es más prevalente en la edad media o pacientes mayores, sin embargo la exposición continua a música a un alto volumen puede llevar a la pérdida auditiva neurosensorial en adolescentes.

¿Cuándo se debe realizar un examen de audición?

Un examen de audición se debe llevar a cabo en chicos que tienen infecciones de oído frecuentes, pérdidas auditivas que duran mas de seis semanas o líquido en el oído medio por mas de tres meses. Hay una amplia gama de instrumentos para evaluar la audición del niño, la función de la trompa de Eustaquio y la movilidad de la membrana del tímpano. Ellos incluyen otoscopía, timpanometría y audiometría.

¿Pierden los niños su audición por otras razones aparte de la otitis media crónica?

Los niños pueden tener pérdidas auditivas temporarias por otras razones más allá de la infección crónica del oído medio y la disfunción de la trompa de Eustaquio. Ellas son:

  • Impactación de cerumen (tapón de cera compresivo)
  • Otitis externa: Inflamación del canal auditivo externo, también llamado oído de nadador.
  • Colesteatoma: Una masa de tejido epitelial escamoso y colesterol en el oído medio, generalmente resultado de una otitis media crónica.
  • Otoesclerosis: Enfermedad del laberinto óseo en el oído que es más común en los adultos y caracterizado por la formación de hueso que lleva a la progresiva hipoacusia conductiva. Ocurre debido a la fijación del estribo (uno de los huesecillos del oído). Hipoacusia neurosensorial puede resultar cuando esta involucrado el conducto coclear.
  • Trauma: Un trauma del oído o la cabeza puede causar una pérdida auditiva transitoria o permanente.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is otitis media and ear infection?

Otitis media refers to inflammation of the middle ear. When an abrupt infection occurs, the condition is called “acute otitis media.” Acute otitis media occurs when a cold, allergy, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This can cause earache and fever.

When fluid sits in the middle ear for weeks, the condition is known as “otitis media with effusion.” This occurs in a recovering ear infection. Fluid can remain in the ear for weeks to many months. If not treated, chronic ear infections have potentially serious consequences such as temporary hearing loss.

Why do children have more ear infections than adults?

To understand earaches and ear infections, you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate and uvula. The tube allows drainage of fluid from the middle ear, which prevents it from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed.

The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to prevent the many germs residing in the nose and mouth from entering the middle ear. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiply. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear.

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. It also makes it harder for the ears to clear the fluid, since it cannot drain with the help of gravity. A child’s tube is also floppier, with a smaller opening that easily clogs.

How does otitis media affect hearing?

Most people with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels – equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Suspect hearing loss if one is unable to understand certain words and speaks louder than normal.

Types of hearing loss

Conductive hearing loss is a form of hearing impairment where the transmission of sound from the environment to the inner ear is impaired, usually from an abnormality of the external auditory canal or middle ear. This form of hearing loss can be temporary or permanent. Untreated chronic ear infections can lead to conductive hearing loss. If fluid is filling the middle ear, hearing loss can be treated by draining the middle ear and inserting a tympanostomy tube. The other form of hearing loss is sensorineural hearing loss, hearing loss due to abnormalities of the inner ear or the auditory division of the 8th cranial nerve. Historically, this condition can occur at all ages, and is usually permanent.

When should a hearing test be performed related to frequent infections or fluid?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function and flexibility of the ear drum. They include the otoscopy, tympanometer and audiometer.

Do people lose their hearing for reasons other than chronic otitis media?

Children and adults can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

  • Cerumen impaction (compressed earwax)
  • Otitis externa: Inflammation of the external auditory canal, also called swimmer’s ear.
  • Cholesteatoma: A mass of horn-shaped squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media.
  • Otosclerosis: This is a disease of the otic capsule (bony labyrinth) in the ear, which is more prevalent in adults and characterized by formation of soft, vascular bone leading to progressive conductive hearing loss. It occurs due to fixation of the stapes (bones in the ear). Sensorineural hearing loss may result because of involvement of the cochlear duct.
  • Trauma: A trauma to the ear or head may cause temporary or permanent hearing loss.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it’s your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

What First Aid Supplies Should You Have on Hand in Case of An Emergency?

  • sterile cloth or pads
  • scissors
  • ice pack
  • tape
  • sterile bandages
  • cotton tipped swabs
  • hydrogen peroxide
  • nose drops
  • antibiotic ointment
  • eye pads
  • cotton balls
  • butterfly bandages

Ask “Are you all right?” Determine whether the injured person is breathing and knows who and where they are.

Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.

Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.

Look at the eyes to make sure they move in the same direction and that both pupils are the same size.

If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

  • Call for medical assistance (911).
  • Do not move the victim, or remove helmets or protective gear.
  • Do not give food, drink or medication until the extent of the injury has been determined.
  • Remember HIV…be very careful around body fluids. In an emergency protect your hands with plastic bags.
  • Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.
  • Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.
  • Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

swelling and bruising, such as a black eye
pain or numbness in the face, cheeks or lips
double or blurred vision
nosebleeds
changes in teeth structure or ability to close mouth properly
It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.
If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist – head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face, and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises, cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling, skiing and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

  • deep skin cuts
  • obvious deformity or fracture
  • loss of facial movement
  • persistent bleeding
  • change in vision
  • problems breathing and/or swallowing
  • alterations in consciousness or facial movement

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

  • breathing difficulties
  • deformity of the nose
  • persistent bleeding
  • cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist – head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist – head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voice box), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

  • Be sure the playing areas are large enough that players will not run into walls or other obstructions.
  • Cover unremoveable goal posts and other structures with thick, protective padding.
    Carefully check equipment to be sure it is functioning properly.
  • Require protective equipment – such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.
  • Prepare athletes with warm-up exercises before engaging in intense team activity.
  • In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes – check the path of travel, making sure there are no obstructing fences, wires or other obstacles.
  • Enlist adequate adult supervision for all children’s competitive sports.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

More than three million American children have a hearing loss, and an estimated 1.3 million of them are under three years of age. Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them. If at any time you suspect your baby has a hearing loss, discuss it with your doctor. He or she may recommend evaluation by an otolaryngologist – head and neck surgeon (ear, nose and throat specialist) and additional hearing tests.

Hearing loss can be temporary, caused by ear wax, middle ear fluid,or infections. Many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

However, some children have sensorineural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable hearing, and children as young as three months old can be fitted with hearing aids.

Early diagnosis is crucial in the management of pediatric hearing loss. When diagnosis is delayed, there can be significant impact on speech and language development. Early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child’s existing hearing. This means your child will get a head start on speech and language development.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

As the parent of a child with newly diagnosed hearing loss, you will have many questions and concerns regarding the nature of this problem, its effects on your child’s future, treatment options and resources. This brief guide will give you necessary initial information, and provide guidance about the availability of resources and the respective roles of different care providers.

It is always difficult for parents to receive bad news about any aspect of their child’s health. Reacting with anger, grief and even guilt are not unusual when finding out that your child is hearing-impaired. These feelings are best managed by discussing them with a family member, close friend, clergy or mental health professional. At times, the feeling may also result in a degree of denial. Feel free to seek a second opinion, but it is unadvisable to delay further recommended diagnostic evaluations for your child. The best treatment for hearing loss of any degree is appropriate early intervention. Significant delays may result in irreversible harm to your child’s hearing, speech, language and eventual educational development.

You will come into contact with many healthcare and rehabilitation specialists during the long-term management of your child’s hearing loss. Some of them will be involved early in the journey and again at intervals. Others may step in later on. The following are professionals you will encounter and the role each of them will play in managing your child’s hearing loss.

The Audiologist

The audiologist is likely to be the first professional you encounter, and possibly the one who gives you the initial news regarding your child’s hearing loss. The audiologist will carry out behavioral or objective testing (such as auditory brainstem responses) or a combination of these approaches to determine the degree and type of hearing loss. The audiologist will also eventually recommend appropriate amplification, following a medical consultation. The audiologist will also provide your child with well-fitting ear molds along with the hearing aids, as he or she grows. The audiologist may also be the professional who provides you with information and referral to an early intervention program. Over time, the audiologist will provide periodic follow-ups to chart your child’s progress and to monitor his or her hearing loss.

Otologist, Otolaryngologist or Pediatric Otolaryngologist (ENT Physician)

Upon diagnosis of hearing loss, your child will be referred to an ear, nose and throat specialist (otolaryngologist), or one who specializes in childhood ear and hearing problems. This physician’s initial role is to determine the specific nature of the underlying problem that may be at least partially causing the hearing loss. Additionally, the physician will also determine if the problem is medically or surgically treatable, and if so, provide the necessary medical or surgical treatment. Such treatments could include something relatively simple, like the placement of eardrum ventilation tubes, or more complex surgical procedures. The ENT specialist may also refer your child for additional diagnostic procedures such as imaging studies (X-rays, CT-scans, MRI scans) to further define the type and source of hearing loss. The doctor will also provide clearance for hearing aid fitting, after determining if no other intervention is indicated. If it is determined that your child needs a cochlear implant, the otolaryngologist, along with the audiologist, will carry out further tests and examinations, and will carry out the implant surgery.

Primary Care Physician: Pediatrician or Family Practitioner

Your child’s primary care physician may be either a pediatrician or a family practice doctor. If your child is not diagnosed with a hearing loss in the newborn period but develops hearing loss later in life, it is the responsibility of this doctor to make appropriate referrals to an ear, nose and throat specialist and an audiologist to rule out or diagnose hearing loss. Your child’s primary care doctor may also participate in the treatment of ear infections if they appear, or refer them to an otolaryngologist for treatment. The primary care physician or the otolaryngologist may also provide a referral to a doctor who specializes in medical genetics, to find out if your child’s hearing loss may be hereditary. That may help you determine if a similar hearing loss could occur in your other children.

Early Intervention Specialist

This professional is typically is someone with an education background. He or she can help you find resources in your community, define family members’ roles in early intervention and management of the hearing loss, and can help you deal with questions regarding future educational placement. This specialist will also help you deal with your observations and concerns about your child and give you information and support regarding your child’s educational needs in the future.

Speech/ Language Pathologist (SLP)

This professional will evaluate the impact of your child’s hearing loss on speech/language development, and monitor his/her progress, noting if progress with that development is falling behind. If this happens, the SLP may refer back to the audiologist or otolaryngologist to determine if any changes have occurred in your child’s hearing. The SLP will also help your child to learn proper speech production, including correct articulation of speech sounds. If you choose oral communication for your child, in addition to the speech language pathologist your child may also be treated by an auditory-verbal therapist, who can help your child acquire the full range of speech sounds and guide the family to additional medical or audiological treatments. The auditory-verbal therapist will also help the child’s family become familiar with appropriate speech/language, auditory and cognitive developmental milestones you may expect for a child with hearing loss.

Finally, many other people can provide additional assistance for your hard-of-hearing child. Parents of older hard-of-hearing children and hard-of-hearing adults can share their experiences with you and may have suggestions for educational and recreational resources in the community.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Insight into Bell’s palsy, including:

  • What is Bell’s palsy?
  • How is it treated?
  • What if I don’t fully recover?

What is Bell’s palsy?

Bell’s palsy is a fast change to one side of your face resulting in weakness or complete loss of movement. It happens because of damage to the facial nerve of unknown cause. This makes half of your face seem to droop. Although Bell’s palsy typically goes away on its own, facial droop or weakness may keep you from closing the affected eye, change how things taste, make your smile crooked, and sometimes may make you drool.

Bell’s palsy can affect anyone, but is most common in those 15-45 years old. There are some conditions that put you more at risk such as being overweight, having untreated high blood pressure, diabetes, or upper respiratory illness.

Most people with Bell’s palsy get better without medical attention within 2-3 weeks. Many recover completely within 3-4 months. Even without any treatment, 70 percent with this palsy get better within six months.

How does the facial nerve change facial expression?

While a virus may cause facial palsy, no one really knows how this works. It may be due to facial nerve swelling (inflammation). As the nerve travels through a narrow bony canal within the skull, the pressure of such swelling may lead to temporary or permanent facial nerve damage. The facial nerve not only carries nerve impulses to muscles of the face, but also to the tear glands, salivary glands, muscle of a tiny ear bone, and taste fibers of the tongue. This means that those with Bell’s palsy may have a dry eye or mouth, taste loss, and a sagging eyelid or mouth corner.

How is Bell’s palsy treated? What will my doctor do?

Facial weakness can be caused by many things. The determination of Bell’s palsy is made when the doctor finds no other cause of your facial weakness. The doctor will conduct a thorough history and examination, looking for any clear causes of the drooping. Be sure to tell your doctor about any change or discomfort you notice and when you first noticed a change. Unless a cause of the problem is found, your doctor is unlikely to do any additional tests, like laboratory testing or imaging. If your doctor does identify another cause of the facial weakness, then your condition is not Bell’s palsy.

For those 16 years and older, doctors may prescribe steroid medication to calm the swelling, helping the facial nerve to work better. Studies show that steroids are likely to be helpful. Antiviral treatment may also be of some help for Bell’s palsy when used in addition to steroids.

Protecting your eye

With Bell’s palsy you may have trouble shutting your eye. Not being able to close the eye will cause dryness and may cause pain or eye damage. So if you do, tell you doctor. He or she may suggest you use eye drops, ointment, or wear an eye patch while you heal.

What else can I do?

You will want to do everything you can to speed recovery, but so far doctors do not know if things like physical therapy or acupuncture help. Talk to your doctor about what else might help.

What if I don’t fully recover?

Most people with Bell’s palsy recover completely. For the small percentage of patients who do not fully recover the remaining problems can affect how you feel about yourself and being with others in your day-to-day life. Certain corrective procedures, such as weighting the eyelid or surgery to improve your smile may help your self-esteem and your appearance. Talk to your doctor about what might work for you.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Insight into sleeping disorders and sleep apnea

Forty-five percent of normal adults snore at least occasionally and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight people and usually worsens with age. Snoring may be an indication of obstructed breathing and should not be taken lightly. An otolaryngologist can help you to determine where the anatomic source of your snoring may be, and offer solutions for this noisy and often embarrassing behavior.

What causes snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, who may recommend a tonsillectomy and adenoidectomy to return the child to full health.

People who snore may suffer from:

  • Poor muscle tone in the tongue and throat: When muscles are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. Some relaxation is natural during deep sleep, but may become a problem if exacerbated by alcohol or drugs that cause sleepiness
  • Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people may have excess soft tissue in the neck that can lead to airway narrowing. Cysts or tumors are rare causes of airway narrowing.
  • Long soft palate and/or uvula: A long palate narrows the opening from the nose into the throat. The excessive length of the soft palate and/or uvula acts as a noisy flutter valve during relaxed breathing.
  • Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring results. So snoring may only occur during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Why is snoring serious?

Socially
Snoring can make the snorer an object of ridicule and can cause the bed partner to experience sleepless nights and fatigue.

Medically
It disturbs sleeping patterns and deprives the snorer of adequate rest. It may be a sign of obstructive sleep apnea (OSA), which can lead to serious, long-term health problems.

What is obstructive sleep apnea?

Snoring may be a sign of a more serious condition known as obstructive sleep apnea (OSA). OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.

The immediate effect of sleep apnea is that the snorer must sleep lightly and keep the throat muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he or she may be sleepy during the day, which impairs job performance and makes him or her a hazardous driver or equipment operator. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes and many other medical problems.

How is heavy snoring evaluated?

Heavy snorers should seek medical advice to ensure that sleep apnea is not a problem. Heavy snorers include people who snore constantly in any position or who negatively impact a bed partner’s sleep. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate and neck, often using a fiberoptic scope. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction or enlargement of tonsils and adenoids. A sleep study in a laboratory or at home may be necessary to determine if snoring is due to OSA.

All snorers with any of the following symptoms should be evaluated for possible obstructive sleep apnea:

  • Witnessed episodes of breath pauses or apnea during sleep
  • Daytime sleepiness or fatigue
  • High blood pressure
  • Heart disease
  • History of a stroke

What treatments are available?

Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.

Snoring or OSA may respond to various treatments offered by many otolaryngologist – head and neck surgeons:

  • Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
  • Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
  • Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser and radiofrequency. These procedures may be done in the operating room or during an office visit. Several treatments may be required.
  • Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
  • Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
  • A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist or oral surgeon with expertise in sleep dentistry.
  • In some patients, significant weight loss can also improve snoring and OSA.

Do you recommend the use of over-the-counter devices?

There is no specific device recommended. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Different methods include products that help a person avoid sleeping on their back, since snoring is often worse in that position. Some devices open nasal air passages; others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. While a person may find a product that works for him or her, underlying poor sleep quality may remain.

Self-help for the light snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • Avoid tranquilizers, sleeping pills and antihistamines before bedtime.
  • Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
  • Establish regular sleeping patterns.
  • Sleep on your side rather than your back.
  • Elevate the head of your bed four inches.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism. Diseases of thyroid, whether functional (hypothyroidism, hyperthyroidism) or structural (nodule, goiter, cancer) occur very commonly.

A nodule is an area of abnormal growth within the thyroid gland. Some people have a single nodule while others have multiple nodules within the gland. Thyroid nodules, which are particularly common in women, can be tiny to very large in size.

Most thyroid nodules are non-cancerous, do not cause symptoms and do not need any treatment. However, in some cases because of the size, appearance (on radiology tests) or symptoms caused by the nodule further evaluation and treatment is needed.

Some nodules are cancers and need therapy. Other nodules are big enough to cause a goiter, leading to symptoms like difficulty swallowing or breathing. In some cases the nodule can be overactive, making too much thyroid hormone (hyperthyroidism). The best treatment option is based on the type of nodule and the preferences of the patient. In some cases thyroid surgery is necessary.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Other endocrine glands include the pituitary, adrenal and parathyroid glands and specialized cells within the pancreas.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.

What is a thyroid disorder?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

  • An overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
  • An underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis)
  • Thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”.

Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acne, adenoids or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

Hypothyroidism treatment:

  • Thyroid hormone replacement pills

Hyperthyroidism treatment:

  • Medication to block the effects of excessive production of thyroid hormone
  • Radioactive iodine to destroy the thyroid gland
  • Surgical removal of the thyroid gland

Goiters (lumps):

If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He or she may recommend:

  • An imaging study to determine the size, location and characteristics of any nodules within the gland. Types of imaging studies include CT or CAT scans, ultrasound or MRIs.
  • A fine-needle aspiration biopsy – a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, and tissue fluid samples containing cells are taken. Several passes with the needle may be required. Sometimes ultrasound is used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure. This test gives the doctor more information on the nature of the lump in your thyroid gland and may help to differentiate a benign from a malignant or cancerous thyroid mass.

Thyroid surgery may be required when:

  • the fine needle aspiration is reported as suspicious or suggestive of cancer
  • imaging shows that nodules have worrisome characteristics or that nodules are getting bigger
  • the trachea (windpipe) or esophagus are compressed because one or both lobes are very large

Historically, some thyroid nodules, including some that are malignant, have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically, the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed during the same surgery.

Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This decision is usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you pre-operatively.

As an alternative, your surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. There also may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist to answer them in detail.

What happens after thyroid surgery?

During the first 24 hours:

After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include:

  • Bleeding
  • Bleeding under the skin that rarely can cause shortness of breath, requiring immediate medical evaluation
  • A hoarse voice
  • Difficulty swallowing
  • Numbness of the skin on the neck
  • Vocal cord paralysis
  • Low blood calcium

At home:

Following the procedure, if it is determined that you need to take any medication your surgeon will discuss this with you prior to your discharge. Medications may include:

  • Thyroid hormone replacement
  • Calcium and/or vitamin D replacement

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:

  • Numbness and tingling around the lips and hands
  • Increasing pain
  • Fever
  • Swelling
  • Wound discharge
  • Shortness of breath

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.

How is a diagnosis made?

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. In addition, blood tests and imaging studies or fine-needle aspiration may be required. As part of the exam, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Tests your doctor may order include:

  • Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
  • An ultrasound examination of your neck and thyroid
  • Blood tests of thyroid function
  • A radioactive thyroid scan
  • A fine-needle aspiration biopsy
  • A chest X-ray
  • A CT or MRI scan

© 2016 American Academy of Otolaryngology – Head and Neck Surgery